If a certain lifestyle factor aids recovery in areas where little else helps, such as with drug and alcohol abuse, or in preventing violence among inner-city youth and in improving prison-inmate rehabilitation -- all very costly in government dollars -- wouldn't we ignore it at our peril?
This factor, which is linked with enhanced recovery from surgery, longer lives, lower blood pressure, greater ability to handle stress, less drug and alcohol abuse and lowered delinquency and crime rates is the 'R'-word: religion. It already has been included in some, but not much, government-funded research.
Medical education and care is poised on the brink of a paradigm shift in which spiritual activities no longer are ignored as health factors. Increasingly, religious commitment is surfacing as a clinically relevant factor in medical recovery. A recent study at Dartmouth Medical School showed that a consistent predictor of who survived heart surgery was the strength of a patient's religious commitment. In this study of 232 patients, those who said they derived no strength or comfort from their religious faith had almost three times the risk of death in the six months following surgery compared to patients who found at least some strength. None of the deeply religious died, compared to 12 percent of those who rarely or never went to church. If the study had omitted religious-commitment variables, this would not have been discovered, and a means for enhancing recovery would have been ignored in favor of a costly medical procedure.
As a result of the significance of these findings, Dr. Thomas Oxman and his colleagues suggested that inquiring about a person's religious commitment can be as important to a patient's health prognosis as inquiring about other lifestyle habits such as smoking: 'Cigarette smoking and hypertension are risk factors for coronary-artery disease through still unknown mechanisms, yet physicians recommend reduction,' they stated. 'Physicians may eventually be advised to make relatively simple inquiries about, and reinforcement of, group participation and religious involvement as routinely as they inquire and advise about cigarette smoking and hypertension.' At 40 of the nation's 126 medical schools, students are now taught to make such inquires.
Similarly, a study of heart-transplant patients at the University of Pittsburgh, found that those with strong beliefs and who participated in religious activities complied better with their medical regimen and had better physical functioning and emotional well-being at their 12-month follow-ups. Likewise, a study of elderly women recovering from hip fractures revealed those with the best surgical outcomes were those to whom God was a strong source of strength and comfort and who frequently attended religious services. Testing showed they were less depressed and could walk down the hall farther at discharge than patients who lacked a strong religious commitment. Enhanced recovery not only diminishes personal suffering, but may lead to lower medical costs and cheaper bills for Medicare and Medicaid.
Dr. Harold Koenig of Duke University Medical Center, whose study was funded by the National Institutes of Health to study patients with life-threatening physical illness provided new evidence with a study published in the April issue of the American Journal of Psychiatry. Koenig's study examined which factors helped patients avoid or recover from depression when facing a life-threatening physical illness.
The article reported that patients who drew upon their religious faith to cope were only half as likely to become depressed. A decline in physical health often precipitates a spiritual crisis, Koenig has written. When serious illness strikes, patients often start to question their purpose in life, the meaning of their work, their relationships and their personal identity, as well as ultimate destiny. Furthermore, patients hospitalized with severe medical illnesses face high stress, including anxiety about their diagnosis, pain and discomfort from their illness and therapeutic procedures, a sense of isolation and loss of control over activities such as eating and sleeping. Consequently, almost one-half of hospitalized patients experience some degree of clinical depression. Koenig reported that nearly 40 percent of seriously ill patients said that religious beliefs or practices were their most important means of handling stress, and more than half said they coped with their illness to a large extent by relying on spiritual activities such as prayer and scripture reading.
The struggle over treatment paradigms continues in the arena of religious commitment and health. Some researchers and government healthcare policymakers try to explain new findings based on old paradigms, such as attributing the significance to 'nothing but' social support or biased selection of studies. Increasingly, however, they are compelled to recognize a new card in the deck.
David Larson is the president of the National Institute for Healthcare Research in Rockville, Md. Susan Larson, is an independent medical writer.
